ABSTRACT
Introduction: Emergence agitation is a common postanaesthetic complication in children after sevofluraneanaesthesia. We aimed to compare the effects of ketamineand midazolam administered intravenously, before the endof surgery, for prevention of emergence agitation in childrenwho received caudal block for pain relief under sevofluraneanaesthesia.Material and Methods: 100 American Society ofAnaesthesiologists status I children aged 4-11 years scheduledfor inguinal hernia repair, circumcision or orchidopexywere enrolled to the study. Anaesthesia was induced withsevoflurane 8% in a mixture of 50% oxygen and nitrous oxide.After adequate depth of anaesthesia, a laryngeal mask wasplaced and caudal block was performed with 0.5 mL kg−1,0.125% bupivacaine. At the end of the surgery, ketamine0.25 mg kg−1 or midazolam 0.03 mg kg− were given to theirrespective groups. Agitation was assessed using PaediatricAnaesthesia Emergence Delirium scale and postoperative painwas evaluated with modified Children's Hospital of EasternOntario Pain Scale.Results and conclusion: modified Children's Hospital ofEastern Ontario Pain Scale scores were found higher inmidazolam group as compared to ketamine group at 0 minutesand 5 minutes while after 10 minutes, the scores becameinsignificant. Paediatric Anaesthesia Emergence Deliriumscores were found to be higher in midazolam group at 0, 5 and10 minutes as compared to ketamine group, but at 30 minutes,the delirium scores became comparable. Thus, ketaminewas able to prevent Emergence Delirium as well as decreasepain scores better than midazolam following sevofluraneanaesthesia in children with caudal block
ABSTRACT
Introduction: Epidural anasthesia is a common method for anaesthetic management after lower limb orthopaedic surgery. The aim is to study the anesthetic effects along with hemodynamics and adverse effects, if any when fentanyl and dexmeditomidine are used as an adjuvant to 0.75% Ropivacaine in epidural anesthesia for major lower limb orthopaedic surgery. Material and methods: The study included 100 cases classified randomly into two groups (each=50): Group RF: Patient receiving epidural anesthesia with 15 ml of 0.75% Ropivacaine and 1microgram/kg Fentanyl. Group RD: Patients receiving epidural anesthesia with 15 ml of 0.75% Ropivacaine and 1microgram/Kg of Dexmeditomidine. Results: The quality of analgesia was better with dexmedetomidine than fentanyl group (p<0.05), andthe requirement for first rescue top up was significantly latter with dexmedetomidine than fentanyl group (p<0.05).In our study while comparing the adverse effects between the two groups we did not found any significant difference between the two groups statistically. The incidence of nausea and vomiting was higher in fentanyl group while incidences of urinary retention, shivering and dry mouth was higher in dexmedetomidine group. Conclusion: Dexmedetomidine is a better adjuvant to epidural ropivacaine compared to fentanyl for epidural anaesthesia in patients undergoing lower limb orthopaedic procedures.